Figure 1.

Alcohol use disorder is characterized by the classical pattern of addiction, namely a cycle from a state of euphoria during alcohol intoxication to that of dysphoria during alcohol withdrawal to one of craving in the absence of acute intoxication. Craving, with or without withdrawal symptoms, is characterized by preoccupation with obtaining alcohol and anticipation of alcohol use, leading to relapse and a return to the intoxicated state. Certain individual clinical characteristics or psychosocial factors can exacerbate this cycle, driving alcohol use and addiction. For example, impulsivity renders an individual more sensitive to the immediate, rewarding effects of alcohol intake, with minimization of any longer term negative consequences, driving alcohol intake. Adolescence alone is characterized by an increased sensitivity to the rewarding effects of alcohol with a protection from the negative effects relative to aged counterparts, driving alcohol intake for this group. Adolescence is often characterized by impulsivity and together these characteristics facilitate alcohol intake. Also they require higher doses of ethanol to produce anxiolysis and sedation. Withdrawal from alcohol can both induce anxiety or depression symptoms and be worsened by comorbid mood disorders. Anxiety or depression can separately be exacerbated by other stressors, acute or chronic, and has been shown to be increased over the long term by environmental insults during development (early adversity). Stress and/or mood decompensation can also, in the absence of withdrawal dysphoria, directly stimulate craving and relapse, driving the cycle of addiction at either stage.